Individual
CLINT S LANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
703 S FLEISHEL AVE STE 5000, TYLER, TX 75701-2015
(903) 606-7525
(903) 606-7284
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP135380
TX
363LF0000X
Family Nurse Practitioner
Primary
AP135380
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
378693101
—
TX
01
—
75-2616977-123
TRICARE
TX
01
—
8HY590
BCBS
TX
01
—
MEDICARE
616096YMAF
TX
01
—
P01938179
MEDICARE RAIL ROAD
TX
Enumeration date
10/16/2017
Last updated
04/22/2026
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